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Pancoast Tumor

Pancoast Tumor Facts

  • A Pancoast tumor is a lung cancer located at the very top (apex) of the lung.
  • The Pancoast tumor is defined by its location. Pancoast tumors are sometimes referred to as superior sulcus tumors.
  • Most Pancoast tumors are non-small cell lung cancers (NSCLC); a few are small cell lung cancers (SCLC).
  • Pancoast tumors spread to the tissues around them, including the neck and chest nerves, ribs, and vertebrae.
  • Symptoms of this disease may be referred to as Pancoast syndrome and include pain in the shoulder, inner side of the arm, and hand.
  • Pancoast tumors rarely produce symptoms related to the lungs themselves, such as chest pain or cough.
  • Treatment for Pancoast tumors involves a combination of surgery, chemotherapy, and radiation.

What Is a Pancoast Tumor?

Pancoast tumors are lung cancers that form at the extreme apex (very top; plural=apices) of either the right or left lung in the superior sulcus (a shallow furrow on the surface of the lung). Because of their location in the top of the lung, they invade adjoining tissue and produce characteristic symptoms. They form an abnormal patch of tissue over the lung apex and principally involve the chest wall structures rather than the underlying lung tissue. They invade the following structures:

  • Lymphatics (small, thin vessels that carry lymph fluid through the body)
  • Lower roots of the brachial plexus (a complex network of nerves that is formed chiefly by the lower four cervical [neck] nerves and the first thoracic [chest] nerve)
  • Intercostal nerves (nerves that lie between a pair of adjacent ribs)
  • Stellate ganglion (a mass of nerve tissue containing nerve cells that form an enlargement on a nerve or on two or more nerves at their point of junction or separation)
  • Sympathetic chain (either of the pair of ganglionated lengthwise cords of the sympathetic nervous system that are situated on each side of the spinal column)
  • Adjacent ribs
  • Vertebrae

Carcinomas (cancerous tumors) in the superior pulmonary sulcus produce the Pancoast syndrome, which is characterized by pain in the shoulder and along the inner side of the arm and hand. Pancoast tumors tend to spread to the tissue surrounding them in the early stage of the disease. As long as the cancer has not metastasized (spread) and involved the regional lymph nodes (small, bean-shaped structures found throughout the body), these tumors can be successfully treated.

It is important to note that a Pancoast tumor is defined by its location in the top portion of the lung. The term does not refer to a specific subtype of lung cancer such as small cell lung cancer (SCLC) or non-small cell lung cancer (NSCLC). Most Pancoast tumors are NSCLC of the squamous cell carcinoma type, although adenocarcinomas and large cell carcinomas can also form in the lung apex and be referred to as Pancoast tumors. A small percentage (3%-5%) of Pancoast tumors are SCLC.

Last Reviewed 9/11/2017

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Pancoast Tumor Diagnosis

Chest X-ray

A chest X-ray test is a very common non-invasive radiology test that produces an image of the chest and the internal organs.

To produce a chest X-ray test, the chest is briefly exposed to radiation from an X-ray machine and an image is produced on a film or into a digital computer.

Chest X-ray is also referred to as a chest radiograph, chest roentgenogram, or CXR.

Depending on its density, each organ within the chest cavity absorbs varying degrees of radiation, producing different shadows on the film.

Chest X-ray images are black and white with only the brightness or darkness defining the various structures. For example, bones of the chest wall (ribs and vertebrae) may absorb more of the radiation and thus, appear whiter on the film.

On the other hand, the lung tissue, which is mostly composed of air, will allow most of the radiation to pass through, developing the film to a darker appearance. The heart and the aorta will appear whitish, but usually less bright than the bones, which are more denser.

Read What Your Physician is Reading on Medscape

Pancoast Tumor »

In 1932, Pancoast defined a superior pulmonary sulcus tumor as a mass growing at the thoracic inlet that produces a constant and characteristic clinical presentation of pain in an eighth cervical or first and second thoracic trunk distribution.

Read More on Medscape Reference »

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